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Once daily gentamicin dosing in adults

THESE GUIDELINES ARE FOR USE WITHIN THE MAIDSTONE & TUNBRIDGE WELLS NHS TRUST ONLY

Gentamicin is an aminoglycoside antibiotic which is active against most gram negative bacteria inlcuding Pseudomonas sp.

1. Once daily gentamicin

A once daily gentamicin regime is easier to administer for nursing staff, requires pre-dose (trough) monitoring and is generally considered less nephrotoxic than the conventional multiple daily dosing regimens.

Dose reduction is required in renal impairment (see table 1), as gentamicin is excreted into the urine by glomerular filtration.

Dose reductions must be based on creatinine clearance (CrCl). The Cockcroft-Gault equation is used to calculate creatinine clearance as an estimate of glomerular filtration rate (GFR) rather then the automated eGFR produced by pathology as there can be a signifcant difference between the two calculations.

A trough, or pre-dose, level is required 18-24 hours after the first dose (see flow chart below)

It is not necessary to take a post dose (or peak) level for once daily dosing

The pre-dose (or trough) level must be below 1mg/L to minimise toxicity

Flow chart for monitoring once daily gentamicin at MTW

Guidelines on once daily monitoring dosing in adults: Produced by the Antimicrobial Stewardship Group 2015. These guidelines are not comprehensive - consult a Microbiologist if more advice is required. For dosing in renal/hepatic failure, seek advice from a Pharmacist.

On this website you will now see four icons for these resources rather than two. Please use BNF Legacy or BNF for Children Legacy as these will take you to the original format of the online publications which do not have any errors or omissions.